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Biomedical subjects

S C Deresinski

Publications and source records attributed to S C Deresinski.

At least 19 recordsLinked to original sources
PubMed1992

Treatment of Mycobacterium avium complex bacteremia in AIDS with a four-drug oral regimen. Rifampin, ethambutol, clofazimine, and ciprofloxacin. The California Collaborative Treatment Group.

OBJECTIVE: To determine the quantitative microbiologic response and the clinical response of patients with Mycobacterium avium complex bacteremia and AIDS to an oral antimycobacterial regimen. DESIGN: A phase II, multicenter clinical trial. SETTING: Four university-affiliated medical centers. PATIENTS: Forty-one patients with HIV infection who had at least two consecutive blood cultures positive for M. avium complex and who had not received previous antimycobacterial therapy were enrolled in the study. Thirty-one patients were evaluable with regard to the efficacy of the oral regimen. INTERVENTIONS: Patients received a combination of orally administered rifampin (600 mg), ethambutol (15 mg/kg body weight), clofazimine (100 mg once daily), and ciprofloxacin (750 mg twice daily) for 12 weeks. Parenterally administered amikacin, 7.5 mg/kg daily for 4 weeks after the first 4 weeks of oral therapy, was used at the discretion of the individual investigator. MEASUREMENTS: Clinical symptoms, Karnofsky scores, and adverse events were monitored. Colony counts for M. avium complex were determined. MAIN RESULTS: The mean logarithmic (log) baseline colony count decreased from 2.1 to 0.7 after 4 weeks of oral therapy (P less than 0.001). Suppression of bacteremia was sustained throughout therapy. Thirteen patients (42%) became culture negative during therapy. The mean duration of treatment was 9.7 weeks. Nineteen evaluable patients (61%) completed 12 weeks of therapy. Adverse reactions to one or more agents were common. CONCLUSIONS: A rapid reduction in symptoms and bacteremia can be achieved as early as week 2 of therapy using an oral regimen of rifampin, ethambutol, clofazimine, and ciprofloxacin. Colony counts rose dramatically after therapy was discontinued, suggesting that more prolonged periods of therapy are necessary to eradicate systemic infection.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Intracellular glutathione levels in T cell subsets decrease in HIV-infected individuals.

The authors have shown previously that intracellular glutathione (GSH) plays an important role in the regulation of human immunodeficiency virus (HIV) transcription and replication in vitro, through modulation of signal transduction by inflammatory cytokines. Moreover, intracellular GSH levels are known to regulate T-lymphocyte function. In multiparameter FACS studies presented here, we show that relative GSH levels in CD4+ and CD8+ T cells from HIV+ individuals are significantly lower than in corresponding subsets from uninfected controls. These studies define the relative intracellular glutathione (GSH) levels in CD4+ T cells, CD8+ T cells, B cells, and monocytes from 134 HIV-infected individuals and 31 uninfected controls. The greatest decreases in intracellular GSH occur in subsets of T cells in individuals in the later stages of the HIV infection. In AIDS patients, GSH levels are 63% of normal in CD4+ T cells (p less than 0.0001) and are 62% of normal in CD8+ T cells (p less than 0.0001). Similarly, in AIDS-related complex (ARC) patients, GSH levels are 66% of normal in CD4+ T cells (p less than 0.003) and are 69% of normal in CD8+ T cells (p less than 0.003). These findings suggest that low intracellular GSH levels may be an important factor in HIV infection and in the resulting immunodeficiency.

AIDS-Related Complex↗
PubMed1992

Atypical papulovesicular rash due to infection with Rickettsia conorii.

We present an unusual case of Rickettsia conorii infection that was associated with cutaneous papulovesicular lesions on a patient who had returned from the bushveld of South Africa. The lesions were diffusely scattered across the trunk, extremities, and both palms. Several recent reports have documented similar papulovesicular or pustulovesicular rashes that occurred on travelers returning from southern Africa. These rashes resemble the lesions of rickettsialpox. Evidence suggests that these atypical exanthems may be due to variant strains of R. conorii or to an unusual host response to infection with this organism; thus, infection with R. conorii should be included in the list of diseases that cause poxlike lesions.

Antibodies, Bacterial↗
PubMed1992

Prevalence of measles antibodies in adults with HIV infection: possible risk factors of measles seronegativity.

OBJECTIVES: To determine the prevalence of measles (rubeola) immunity in a group of HIV-1-infected adults and to examine predictors of measles seronegativity in this population. SETTING: County hospital outpatient clinic and public-health department early HIV intervention clinic. PATIENTS: A total of 262 HIV-infected adults presenting to outpatient clinics between September 1990 and January 1991. INTERVENTIONS: Patients were screened for the presence of measles immunoglobulin G antibody, as measured by an enzyme-linked immunosorbent assay (ELISA). Pertinent clinical and immunologic information was recorded. Univariate and multivariate analyses were performed to identify possible risk factors for measles seronegativity. MAIN OUTCOME MEASURE: Measles seronegativity, as defined by a lack of detectable antibody (ELISA predicted index value < 1.0). RESULTS: Thirteen (5%) patients lacked serologic evidence of immunity. Risk factors for measles seronegativity included year of birth in 1957 or later, Caucasian (non-Hispanic) race and oral hairy leukoplakia. Factors associated with progressive HIV disease (other than hairy leukoplakia) were not associated with a lack of existing immunity. CONCLUSIONS: A high prevalence (95%) of measles antibody was found in this large group of HIV-infected adults. Young, white individuals born in 1957 or later were at the greatest risk for measles seronegativity, but declining immunity due to progressive HIV infection did not appear to be associated with a lack of antibody. Self-reported histories of measles infection or immunization were not reliable predictors of measles immunity.

AIDS-Related Opportunistic Infections↗
PubMed1992

CD20 expression is increased on B lymphocytes from HIV-infected individuals.

In studies presented here, we show that expression of the pan B cell marker CD20 is markedly increased on B lymphocytes from HIV-infected individuals and that this increase tends to be greater in individuals with more advanced disease. By using multiparameter FACS analyses to quantitate surface density of CD20 and intracellular glutathione (GSH) levels simultaneously, we further show that the distribution of intracellular glutathione (GSH) levels in B cells of HIV-infected individuals is more heterogeneous than in uninfected controls. Finally, we show that the intracellular GSH levels correlate with CD20 expression on a per-cell basis in all infected individuals. These findings suggest that CD20 expression, which can be precisely measured, may prove to be a useful surrogate marker for monitoring HIV infection.

Antigens, CD↗
PubMed1992

T-HELPER: automated support for community-based clinical research.

There are increasing expectations that community-based physicians who care for people with HIV infection will offer their patients opportunities to enroll in clinical trials. The information-management requirements of clinical investigation, however, make it unrealistic for most providers who do not practice in academic centers to participate in clinical research. Our T-HELPER computer system offers community-based physicians the possibility of enrolling patients in clinical trials as a component of primary care. T-HELPER facilitates data management for patients with HIV disease, and can offer patient-specific and situation-specific advice concerning new protocols for which patients may be eligible and the treatment required by those protocols in which patients currently are enrolled. We are installing T-HELPER at three county-operated AIDS clinics in the San Francisco Bay Area, and plan a comprehensive evaluation of the system and its influence on clinical research.

Clinical Trials as Topic↗
PubMed1991

Inflammatory pseudotumor of intra-abdominal lymph nodes manifesting as recurrent fever of unknown origin: a case report.

A 27-year-old man presented with a 7-month history of debilitating recurrent fever and weight loss. Extensive clinical evaluation led to the discovery of splenomegaly and retroperitoneal lymphadenopathy. The patient underwent splenectomy as well as liver and lymph node biopsy. Histologic examination of the lymph nodes, but not the liver and spleen, revealed inflammatory pseudotumor of lymph nodes. The patient has remained asymptomatic for more than 3 years following the surgical procedure despite the absence of further intervention. Inflammatory pseudotumor of lymph nodes should be considered in the differential evaluation of prolonged or relapsing fever of unknown etiology.

Abdominal Neoplasms↗
PubMed1991

Diagnosis and management of pneumonia.

The management of patients with pneumonia, the fifth leading cause of death in the United States, remains frequently problematical. Because a precise etiologic diagnosis is often not possible when the patient is first examined, initial antibiotic therapy is often empiric. Problems in early diagnosis include the frequent lack of access to true respiratory secretions, necessary delays in identification of organisms in culture, and contamination of expectorated sputum with oropharyngeal bacteria. Early management must therefore depend on epidemiologic and clinical clues as well as examination of available respiratory secretions. It is generally helpful in the selection of initial antibiotic therapy to consider the disease in two broad epidemiologic categories, community- and nosocomially acquired. As new laboratory and clinical information become available, the appropriateness of the antibiotic therapy must be continually reevaluated.

Anti-Bacterial Agents↗
PubMed1990

Visceral bacillary epithelioid angiomatosis: possible manifestations of disseminated cat scratch disease in the immunocompromised host: a report of two cases.

Opportunistic infection with the causative agent of cat scratch disease may be responsible for an unusual vascular proliferative lesion, referred to as bacillary epithelioid angiomatosis, previously described only in human immunodeficiency virus (HIV)-infected patients. We present a case of an HIV-infected patient with bacillary epithelioid angiomatosis involving the liver and bone marrow causing progressive hepatic failure. We also report a case of a cardiac transplant recipient with hepatic and splenic bacillary epithelioid angiomatosis manifesting as a fever of unknown origin, a previously unreported event in a non-HIV-infected patient. These cases represent the first documentation of bacillary epithelioid angiomatosis with visualization of cat scratch-like organisms involving internal organs.

Adult↗
PubMed1990

Low-dose dapsone prophylaxis of Pneumocystis carinii pneumonia in AIDS and AIDS-related complex.

The efficacy, toxicity and cost of orally administered dapsone (50-100 mg/day) for prophylaxis of Pneumocystis carinii pneumonia (PCP) were evaluated in 30 patients with AIDS or AIDS-related complex (ARC). Six patients received primary and 24 secondary prophylaxis. Ten patients received a maximum dose of 100 mg/day and 20 a maximum of 50 mg/day for a median duration of 19 weeks; 22 of the 30 patients continue to receive prophylaxis as of May 1989. Four patients have died, none of pneumocystis infection. One patient with AIDS suffered a mild relapse while receiving 50 mg/day. Hematologic toxicity was mild and could not be definitively attributed to dapsone therapy; rash due to dapsone was documented in two patients. A review of 33 patients at our institution with a history of PCP who received no prophylaxis demonstrated seven relapses, three of which were fatal. Cost analysis revealed a significant advantage for oral dapsone over aerosolized pentamidine.

AIDS-Related Complex↗
PubMed1989

The hamster model of chronic Mycobacterium avium complex infection.

Male golden Syrian hamsters were evaluated as a model for the pathogenesis of human infection with Mycobacterium avium complex. Intratracheal inoculation produced a chronic, nonfatal, pulmonary and disseminated infection (overall rate, 86%). The frequency of infection in hamsters that received 5 x 10(8) versus 1 x 10(8) colony forming units (cfu) was not significantly different (87% and 92%, respectively), but 1 x 10(7) cfu produced infection in only 78% of inoculated animals (P = .034). The percentage of animals developing pulmonary infection with M. avium complex did not differ between inoculum groups (77%-80%). Disseminated infection occurred significantly less frequently in the 1 x 10(7) group (46%) compared with the 5 x 10(8) (79%) and 1 x 10(8) (68%) groups (P = .001 and .056, respectively). After seven weeks, partial clearance of M. avium complex from the lungs coincided with an increased number of animals with splenic involvement. The hamster may be a useful model for human infection with M. avium complex.

Animals↗
PubMed1985

Urinary tract infections in male spinal cord injured patients. Part one: Bacteriologic diagnosis.

Seventy-one paired samples of urine, obtained by collection of a clean voided specimen and by suprapubic aspiration of the bladder (SPA), were obtained from 53 male spinal cord injured patients who were free of indwelling catheters. A direct comparison of the number of colony forming units of bacteria within the paired specimens indicates that single voided specimen is adequate in 63 of 71 (88.7%) instances. While using a threshold of 10(4) organisms per cc of urine obtained by SPA, the presence of at least 10(4) organisms per cc of voided urine provided a sensitivity and specificity both of 100%. Such high degree of correlation between SPA and voided specimen is explained on the basis of altered urodynamics in these patients and repeated contamination and transmission of bacteria from anterior urethra into the bladder. In patients with colony counts of 10(2) to 10(4) per cc, in which the voided urine contains mixed flora or staphylococci, bladder urine is most likely to be sterile and accurate assessment may require SPA of the bladders. The lack of normal voluntary control of bladder emptying in these patients made collection of SPA samples easier than voided specimens. Conventionally accepted criteria for the diagnosis of urinary tract infection lack sensitivity when applied to this group of patients.

Bacteriological Techniques↗
PubMed1985

Urinary tract infections in male spinal cord injured patients. Part two: Diagnostic value of symptoms and of quantitative urinalysis.

Seventy paired samples of urine, obtained by collection of a clean voided specimen and by suprapubic aspiration (SPA) of the bladder, were obtained from 43 male SCI patients who were free of indwelling catheters. The relationship of the presence or absence of symptoms and the degree of pyuria (determined quantitatively using a haemocytometer) to the presence or absence of bacteriuria (SPA specimen) was determined. Symptoms were poorly predictive of bacteriuria with concordance seen only 40% of the time. Most bacteriuric episodes (37/51-72.5%) were asymptomatic. The quantity of WBC in voided urine accurately reflected that in SPA urine (r = 0.825), indicating that urodynamics in SCI patients who received sphincterotomies are different than in normal persons. Pyuria (greater than or equal to 10(4) WBC per cc urine) was an excellent predictor of UTI--37 of 38 (97.4%) had UTI. However, 40.6% of samples with WBC less than 10(4) were also culture positive. Overall, consideration of the presence or absence of pyuria in relation to the presence of bacteriuria provided a sensitivity of 74.0%, specificity of 95.9%, and predictive value of a positive test of 97.4%. The predictive value of a negative test (WBC less than 10(4), however, was only 59.4%. There was poor correlation between absolute bacterial and WBC count. The point of cutoff for bacterial count correlating with 10(4) WBC count was not statistically significant in these patients; this is possibly due to repeated bacterial contamination from anterior urethra. While symptom status was often misleading, the presence of greater than 10(4) WBC per cc of urine was highly predictive of the presence of bacteriuria in male SCI patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMed1979

Association of ABO blood group and outcome of coccidioidal infection.

Dissemination of fungal infection due to Coccidioides immitis has been previously shown to be related to hereditary factors. Two associations reported to date are race (e.g., Filipino and black ancestry) and HLA histocompatibility type (HLA-19). In the present study of 105 patients a significant association of blood group B and dissemination is demonstrated. C. immitis is known to possess antigens with blood group A activity. Previous epidemiologic studies have also shown HLA-A9 and blood group B are both more common in persons of black and Filipino ancestry. Further studies are needed to define whether these are independent variables, and may define subgroups at particularly high risk following coccidioidal infection.

ABO Blood-Group System↗
PubMed1978

Coccidioides immitis endospores: phagocytosis by human cells.

Phagocytosis of killed endospores by glass adherent peripheral human mononuclear cells was studied. Phagocytosis continued through 30 minutes of incubation. No difference in rates of ingestion could be detected when cells from coccidioidin-reactive and nonreactive subjects were compared although both groups ingested endospores more avidly than latex particles.

Cells, Cultured↗